Background: Volume-outcome relationships in pancreatic surgery are well established, but an optimal volume remains to be determined. Studies analyzing outcomes in volume categories exceeding 20 procedures annually are lacking. Study design: A consecutive 3420 patients underwent PD for primary pancreatic or periampullary carcinoma (2005-2013) and were registered in the Netherlands Cancer Registry. Relationships between hospital volume (<5, 5-19, 20-39 and >40 PDs/year) and mortality and survival were explored. Results: There was a non-significant decrease in 90-day mortality from 8.1 to 6.7% during the study period (p = 0.23). Ninety-day mortality was 9.7% in centers performing <5 PDs/year (n = 185 patients), 8.9% for 5-19 PDs/year (n = 1432), 7.3% for 20-39 PDs/year (n = 240) and 4.3% for >40 PDs/year (n = 562, p = 0.004). Within volume categories, 90-day mortality did not change over time. After adjustment for confounding factors, significantly lower mortality was found in the >40 category compared to 20-39 PDs/year (OR = 1.72 (1.08-2.74)). Overall survival adjusted for confounding factors was better in the >40 category compared to categories under 20 PDs/year: HR (>40 vs 5-19/year) = 1.24 (1.09-1.42). In the >40 category significantly more patients received adjuvant chemotherapy and had >10 lymph nodes retrieved compared to lower volume categories. Conclusions: Volume-outcome relationships in pancreatic surgery persist in centers performing >40 PDs annually, regarding both mortality and survival. The volume plateau for pancreatic surgery has yet to be determined.

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Journal HPB
van der Geest, L.G.M, van Rijssen, L.B, Molenaar, I.Q, de Hingh, I.H.J.T, Groot Koerkamp, B, Busch, O.R.C, … Besselink, M.G. (2016). Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB, 18(4), 317–324. doi:10.1016/j.hpb.2016.01.515